Analysis & Opinion

NEW YORK (Reuters Health) - There still isn't enough evidence to say whether office- or home-based programs ordered by doctors actually prevent child abuse when obvious signs of maltreatment are absent, according to a government-backed panel.

The lack of a recommendation - known as an I statement, for "insufficient" - from the U.S. Preventive Services Task Force (USPSTF) echoes the same group's 2004 conclusion, which also found a lack of evidence for or against child abuse prevention programs being applied to all kids, instead of just those clearly at risk.

"It is about interventions that can occur in the primary care office or can be referred by the doctor to someone in the community," said Dr. David Grossman, a member of the panel and a senior investigator at the Group Health Research Institute in Seattle.

"It is disappointing because we had hopes that we could uncover evidence to convert it from an I statement to something more positive," Grossman said.

Approximately 680,000 children younger than 18 years old were victims of maltreatment in 2011 and more than 1,500 died from it. That includes physical, sexual and psychological abuse.

The kids who survive abuse, according to the panel, are at increased risk for a number of troubles later in life, including psychological disorders and physical ailments, such as chronic pain and diabetes.

"Although we recognize the extreme importance of this issue and the protection of children should be paramount… The role of the primary care physicians in being the prevention, so to speak, is unclear because there is not enough evidence to say what doctors can do to prevent abuse in the first place," Grossman told Reuters Health.

In January, the USPSTF published a draft of its findings, which are based on a review of 10 past studies of home-based interventions and one office-based program to reduce the number of related Child Protective Services (CPS) family reports and emergency room visits by kids (see Reuters Health article of January 22, 2013 here: reut.rs/13xjBZO.)

Some of the programs were tied to drops in CPS family reports and child ER visits but others found no link, according to the review.

Dr. Lynn K. Sheets, medical director of child advocacy and protection services at Children's Hospital of Wisconsin in Milwaukee, said the panel's conclusion is "not surprising because there are methodological challenges to doing research on high-risk groups." She added that it's also hard to study interactions that happen in a doctor's office.

But Sheets, who was not involved in crafting the new recommendations, said she thinks some people may misinterpret the conclusion to mean doctors shouldn't try to prevent child abuse.

"It doesn't mean we shouldn't continue to screen and prevent child abuse in the best ways we know how," she said.

Grossman told Reuters Health that the panel's final conclusion, which was published on Monday in the Annals of Internal Medicine, doesn't apply to interventions involving children with obvious signs and symptoms of abuse.

"It's a whole different ball game for a pediatrician or primary care physician when a child comes in with signs and symptoms of abuse. Everyone is aware in that case about the protocols they need to follow," he said.

But the USPSTF emphasized that filling gaps in the research should be a priority. For instance, the panel wrote, the relationship between harsh punishment, such as spanking, and abuse needs further exploration, "as does that between intimate partner violence and child maltreatment."

The report also flagged the need for research to determine effective ways for health care providers to identify children at risk for abuse or currently being abused, and for studies to find effective ways to prevent maltreatment of older children in particular.

Grossman said the hope is that the panel will be able to make more of a recommendation once additional studies are done.

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